National Health Plan 2021-2030, Volume 1B: Key Interventions

Objectives

The National Health Plan 2021–2030 seeks health and wellbeing for all people in Papua New Guinea through compassionate, equitable, affordable and quality healthcare, placing families, villages and disadvantaged populations at the centre of service delivery. It aims to empower communities to identify and act on their own health priorities while pursuing universal health coverage without financial hardship.[1][2][3]

• Increase access to quality and affordable services through strengthened primary healthcare, rural access, integrated prevention and care, and progressively more complex services across six service-delivery levels.[4][5]
• Build healthier communities through village health assistance, the Healthy Island Concept, health promotion, prevention, community mobilisation and action on social and environmental determinants of health.[6][7][8]
• Address priority disease burdens, including communicable diseases, non-communicable diseases, maternal and child health, sexual and reproductive health, mental health, cancer, nutrition, environmental risks, emergencies and climate-related threats.[5][9][10][11][12]
• Strengthen health systems through workforce development, medical supplies, facilities, financing, information systems, research, regulation, leadership, governance and service-quality standards.[1][13][14]
• Develop ten major interventions: village health assistance; Healthy Island health promotion; stakeholder partnerships; Essential Health Intervention Packages; a National Reference Laboratory; a medical-supplies pull system; revenue-generation options; health regulation; e-health; and a national referral, research and teaching hospital.[6][2]

The plan frames its five key result areas as community engagement, partnerships, access to good-quality and affordable services, targeted disease burdens and health priorities, and stronger health systems.[3][15]Its disease-control agenda combines prevention, diagnosis, treatment, rehabilitation, palliative care, surveillance and emergency response, while seeking to reduce inequities affecting rural, remote and marginalised communities.[4][16][15]

Public-health infrastructure priorities include a proposed National Institute of Public Health and National Reference Laboratory for surveillance, laboratory quality, research, preparedness and outbreak response.[17][18]The national referral, research and teaching hospital is intended to provide complex tertiary care, specialist services, research and teaching, while supporting lower levels of care through referral, outreach and clinical guidance.[19][5]

Implementation

Implementation is organised through national, provincial, district, facility and community responsibilities, using aligned sub-plans, annual implementation plans, budgets, programme strategies and an implementation logframe. Provincial Health Authorities are the principal mechanism for integrated sub-national management and delivery, responsible for resources, partnerships, facilities, workforce, supply chains and people-centred services.[6][2][20]

• Deliver services through a six-level referral system, from village-level health posts and community health posts to health centres, district hospitals, provincial hospitals and the national referral hospital.[5]
• Recruit, train, supervise and incentivise Village Health Assistants as community links to Level 1 health posts, with progression opportunities towards Community Health Worker and Nursing Officer roles.[7][8]
• Package minimum public-health and clinical services through Essential Health Intervention Packages tailored to communities and facility levels, while integrating clinical care, public health and primary healthcare.[17]
• Coordinate partnerships with communities, churches, civil society, private providers, academia, development partners, government agencies and businesses through agreements, stakeholder mapping, committees and the Sector Wide Approach.[21][22][23]
• Strengthen operational systems through medical-supply and procurement planning, upgraded storage, mSupply, demand-based quantification, contract-performance monitoring and medicine-availability monitoring.[24][25]
• Develop secure, interoperable e-health systems, a national information exchange or data hub, provincial information capacity, dashboards, electronic reporting and data standards for evidence-based planning.[19][26][27]

Financial implementation combines government funding, development-partner support, provincial resource mobilisation and possible self-financing mechanisms, including user fees for specified services, a health endowment fund, social health insurance options and selected earmarked taxes subject to feasibility.[24][28]Annual planning and budgeting are led by the National Department of Health, coordinated with the Department of Treasury, and aligned to the January-to-December government budget calendar.[29][30]

Projected investment covers workforce, infrastructure, operations, medicines and procurement, church health services and disease-control programmes.[15]Major quantified projections include 6,480.5 million Kina for human resources over 2021–2030, 20.91 billion Kina for health infrastructure, approximately 1.7 billion Kina for Christian Health Services, and 490 million Kina in rural and remote staff incentives.[31][32][33][34]

Accountability relies on National Health Service Standards, clinical audits, facility assessments, financial monitoring, workforce and supply-chain reporting, and performance reviews.[35][36][14]The monitoring framework uses 205 indicators across the five key result areas, including 16 universal health coverage tracer indicators, with data disaggregated where possible by age, sex, location, region, wealth and education.[26]National and provincial reviews are expected quarterly and annually, supported by Sector Performance Annual Review reports; independent National Health Plan evaluations are scheduled for 2024 and 2029.[37][38]

Monitoring & Evaluation

The monitoring and evaluation framework combines national performance measurement, routine reporting, surveillance, quality assurance and decentralised accountability. It measures progress across five key result areas using 205 indicators and targets to be achieved by or before 2030, alongside a revised set of 37 Sector Performance Annual Review indicators.[26][27][37]

• Measure inputs, outputs, outcomes and impacts, including resource mobilisation and utilisation, service capability and coverage, and intervention results.[26]
• Monitor universal health coverage through 16 tracer indicators for service coverage and financial protection, disaggregating findings by age, sex, urban or rural location, region, wealth and education.[26]
• Integrate data from the National Health Information System, mSupply, surveillance, administrative records, financial and workforce data, facility assessments, household surveys, censuses, research, and civil registration into a national data warehouse.[26][27]
• Strengthen data quality, confidentiality, interoperability, analysis and dissemination through updated reporting guidance, training, supervision, dashboards and independent data-quality assessments.[27][37]
• Conduct quarterly national performance assessments and provincial reviews, provide feedback to sub-national stakeholders, and publish annual Sector Performance Annual Review reports on national and provincial progress, gaps and required actions.[37]
• Undertake independent mid-term and final National Health Plan evaluations in 2024 and 2029, using Performance Assessment Framework data and evidence from frontline and service-delivery staff.[38]
• Apply programme-specific surveillance and quality mechanisms, including disease and laboratory surveillance, medicine-supply monitoring, facility audits, clinical audit toolkits, accreditation surveys, workforce databases, cancer registries, and routine monitoring of vaccine safety, cold chains and service coverage.[17][18][24][39][36][40]
• Maintain accountability through the National and Provincial Health Boards, District Health Committees, provincial health authorities, financial monitoring systems and reporting to the Minister for Health and HIV and AIDS for an annual statement to Parliament.[14][37]

Reporting requirements include complete and timely monthly provincial reports, quarterly expenditure reviews, quarterly clinical-audit reporting in several specialist services, and annual implementation-plan performance assessment.[14][25][41][42]Detailed indicators, targets and reporting arrangements are specified most clearly for the plan-wide performance framework and selected programmes; several intervention extracts do not specify their own quantitative indicators, evaluation methods or accountability arrangements.[26][37]

Costing & Financing

Costing covers recurrent and investment expenditure across the National Health Plan 2021–2030, including human resources, infrastructure, operations, medicines and procurement, church health services, disease-control programmes, laboratory services and research institutions.[15][43]Financing is expected to draw principally on government revenue, supplemented by development partners, provincial and partner agreements, internal revenue generation and potential new financing mechanisms.[24][30][44]

• Allocate approximately 69% of the annual health budget from government, 22% from development partners and 9% from out-of-pocket payments during 2018–2020.[24]
• Link fiscal space largely to economic growth because health funding depends substantially on general government revenue.[24]
• Strengthen financing policy, public financial management, annual planning and budgeting, expenditure tracking, transparent resource allocation and frontline fund flows through provincial health authorities, districts and facilities.[14][22][29]
• Explore efficiency savings, partnerships, social health insurance, a health endowment fund, earmarked taxes on tobacco, alcohol and sugary products, tax infrastructure-credit schemes and user fees for specified services, subject to feasibility.[24][28]
• Estimate aggregate human-resources expenditure at 6,480.5 million Kina for 2021–2030, including incentive payments for rural and remote staff, pre-service training and other workforce objectives.[31][32]
• Estimate infrastructure investment at approximately 20.91 billion Kina for 2021–2030, with expenditure focused principally on facility levels 1–4, provincial hospitals, Port Moresby General Hospital and training institutions.[33][34]
• Project Christian Health Services allocations of approximately 1.7 billion Kina over the plan period, including about 1.3 billion Kina for salaries and allowances.[33]
• Exclude water supply, sanitation and other investments traditionally funded outside the health sector from the expenditure estimates.[43]

Costing assumptions include phased workforce expansion, with one-third of the human-resources gap addressed in 2021–2025 and two-thirds in 2026–2030; unchanged church and other non-government workforce shares; and church-sector salary growth at the government-sector rate.[31][33]The estimates exclude or adjust overlapping expenditure in human resources, infrastructure, referral services and selected disease programmes to limit double counting, but no consolidated financing gap or complete resource-mobilisation plan is specified.[15][45][46]